Critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle

Jansson, Miia; Syrjälä, Hannu; Talman, Kirsi; Meriläinen, Merja; Ala‐Kokko, Tero

doi:10.1016/j.ajic.2018.02.004

Cited by 25 publications

(54 citation statements)

References 24 publications

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“…In a previous study, the main barriers toward lung-protective ventilation included lack of education, role ambiguity, and lack of knowledge. 20 In line with previous literature, late tracheostomy had no impact on VAP rates. 2 Previously, however, late tracheostomy has been associated with morbidity and mortality.…”

Section: Discussionsupporting

confidence: 86%

“…In previous literature, the main barriers toward daily sedation interruption have consisted of lack of education, fear of potential adverse effects (eg, fear of potential self-extubation and risk for worse psychological outcomes), situation-related barriers, lack of guidelines, inadequate resources, role ambiguity, and patient discomfort (eg, pain, and anxiety associated with lightening sedation). [18][19][20] The rate of unplanned extubations 19 and long-term psychological effects, 18 however, have not differed between patients with and without sedation or daily sedation interruption.…”

Section: Discussionmentioning

confidence: 99%

“…In previous literature, the main barriers toward SBT have been identified as lack of education, role ambiguity, fear of potential adverse effects, lack of guidelines, disagreement with reported trial results, situation-related barriers, and lack of order. 20 The most frequently chosen weaning mode was PSV with minimal pressure support, whereas in previous literature, the most frequently chosen weaning modes have been CPAP, bilevel positive airway pressure (BIPAP) and PSV. 7 Over three-fourths of the respondents knew that NIV should be used in appropriate patients to decrease the duration of mechanical ventilation.…”

Section: Discussionmentioning

confidence: 99%

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Implementation of strategies to liberate patients from mechanical ventilation in a tertiary-level medical center

Jansson

Syrjälä

Ala‐Kokko

2019

American Journal of Infection Control

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Background. Considerable discrepancies have been observed in the implementation of strategies to liberate patients from mechanical ventilation. The aim of this study was to describe critical care nurses' knowledge of and self-reported and documented adherence to lung-protective ventilation, daily sedation interruption, and daily assessment of readiness to extubate and evaluate how these practices differ between patients with and without ventilator-associated pneumonia and between survivors and nonsurvivors. Methods. The survey was conducted in a tertiary-level hospital in Finland from October 2014 to June 2015. Actual adherence was evaluated based on documentation of performed practices. Results. A total of 86 critical care nurses responded to the survey, and 85 patients were followed. The levels of knowledge of and self-reported adherence to low tidal ventilation were 84.5% and 90.2%, respectively, and the median tidal volume was at a target level in 74.4% of patients. Regarding daily sedation interruption, the level of knowledge was 85.7% and the level of self-reported adherence was 77.3% while documented adherence was 33.3%. The levels of knowledge and self-reported adherence regarding spontaneous breathing trial were 61.9% and 71.6%, respectively. Adherence to lungprotective ventilation, daily sedation interruption, and daily assessment of readiness to extubate did not differ between patients with (n=20) and without (n=65) ventilator-associated pneumonia and between survivors (n=55) and nonsurvivors (n=30). Conclusions. Lung-protective ventilation, including low-tidal ventilation and avoidance of high inspiratory plateau pressures, was well implemented and adhered to. The levels of knowledge and self-reported adherence versus documented adherence regarding daily sedation interruption and spontaneous breathing trial demonstrated insufficient implementation of local guidelines. There was no affect on the outcome.

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Section: Discussionsupporting

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Implementation of strategies to liberate patients from mechanical ventilation in a tertiary-level medical center

Jansson

Syrjälä

Ala‐Kokko

2019

American Journal of Infection Control

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“…In this study, the median level of ICU work experience was 10.0 (5.0-19.3) years. Secondly, more attention should be paid to bundle compliance; increased nursing workload, manifest, for example, in lack of time, lack of personnel, and the lack of clear responsibilities, has resulted in noncompliance with basic VAP prevention guidelines [30]. In addition, strict compliance with infection prevention elements should be monitored [32].…”

Section: Discussionmentioning

confidence: 99%

Association of nurse staffing and nursing workload with ventilator-associated pneumonia and mortality: a prospective, single-center cohort study

Jansson

Syrjälä

Ala‐Kokko

2019

Journal of Hospital Infection

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“…Challenges of applying new research evidence through adapted or revised guidelines are compounded in resource-constrained settings, where infrastructure is poor, HW shortages, and rapid turnover of staff are the norms (Sodhi et al, 2014). In addition, ability to change practices may be beyond the control of individual HWs (Jansson, Syrjälä, Talman, Meriläinen, & Ala-Kokko, 2018).…”

Section: Introductionmentioning

confidence: 99%

An educational intervention to update health workers about HIV and infant feeding

Horwood

Haskins

Goga

et al. 2019

Maternal & Child Nutrition

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Clinical guidelines are used to translate research findings into evidence‐based clinical practice but are frequently not comprehensively adopted by health workers (HWs). HIV and infant feeding guidelines were revised by the World Health Organization to align feeding advice for HIV‐exposed and unexposed infants, and these were adopted in South Africa in 2017. We describe an innovative, team‐based, mentoring programme developed to update HWs on these guidelines. The intervention was underpinned by strong theoretical frameworks and aimed to improve HWs' attitudes, knowledge, confidence, and skills about breastfeeding in the context of HIV. On‐site workshops and clinical mentoring used interactive participatory methods and a simple low‐tech approach, guided by participants' self‐reported knowledge gaps. Workshops were conducted at 24 participating clinics over three sessions, each lasting 1–2 hr. Evaluation data were collected using a self‐administered questionnaire. Of 303 participating HWs, 249/303 (82.2%) attended all workshops. Achieving high workshop attendance was challenging and “catch‐up” sessions were required to achieve good coverage. Common knowledge gaps identified included antiretroviral therapy adherence monitoring during breastfeeding and management of viral load results (173 participants), management of breast conditions (79), and advice about expressing and storing breastmilk (64). Most participants reported all their knowledge gaps were addressed and anticipated that their practice would change. We describe a feasible, sustainable approach to updating HWs on HIV and infant feeding guidelines and improving skills in breastfeeding counselling in resource‐constrained settings. This approach could be adapted to other topics and, with further evaluation, implemented at scale using existing resources.

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Critical care nurses' knowledge of, adherence to, and barriers toward institution-specific ventilator bundle

Cited by 25 publications

References 24 publications

Implementation of strategies to liberate patients from mechanical ventilation in a tertiary-level medical center

Implementation of strategies to liberate patients from mechanical ventilation in a tertiary-level medical center

Association of nurse staffing and nursing workload with ventilator-associated pneumonia and mortality: a prospective, single-center cohort study

An educational intervention to update health workers about HIV and infant feeding

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